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01-01-2018

Exercise therapy and autonomic function in heart failure patients: a systematic review and meta-analysis

Authors: M. J. Pearson, N. A. Smart

Published in: Heart Failure Reviews | Issue 1/2018

Abstract

A large body of evidence exists indicating that autonomic imbalance is characteristic of heart failure, with several parameters of autonomic function associated with adverse clinical outcomes. The aim of this systematic review and meta-analysis was to investigate the effects of exercise training on parameters of autonomic function in patients with heart failure and where possible quantify the size of the effect. We conducted database searches (PubMed, EMBASE and Cochrane Trials Register to 31 March 2017) for exercise-based rehabilitation trials in heart failure; using search terms, exercise training, autonomic function, heart rate recovery, heart rate variability and muscle sympathetic nerve activity. Pooled data indicated a statistically significant increase in heart rate recovery at 1 min (HRR₁) in exercise compared to control groups_, mean difference 5.90 bpm (95%CI 5.12, 6.69; p < 0.00001). Pooled data also indicated that exercise training improved the short-term heart rate variability (HRV) parameters of root mean square of successive differences between normal heart beats (RMSSD (ms)) [mean difference 10.44 (95%CI 0.60, 20.28, p = 0.04)] and high-frequency normalised units (HF_nu) [mean difference 7.72 (95%CI 3.32, 12.12, p = 0.0006), which are predominantly reflective of parasympathetic activity. Analyses also indicated a statistically significant decrease in muscle sympathetic nerve activity (MSNA) bursts/minute (mean difference − 11.09 (95%CI − 16.18, − 6.00; p < 0.0001) and MSNA bursts/100 heart beats (mean difference − 15.44 (95%CI − 20.95, −9.92; p < 0.00001) in exercise groups compared to controls. With improvements in HRR, HRV and MSNA, exercise training appears to facilitate an improvement in parasympathetic tone and reduction in sympathetic activity.

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Florea VG, Cohn JN (2014) The autonomic nervous system and heart failure. Circ Res 114(11):1815–1826. https://doi.org/10.1161/CIRCRESAHA.114.302589 CrossRefPubMed

Verloop WL, Beeftink MM, Santema BT et al (2015) A systematic review concerning the relation between the sympathetic nervous system and heart failure with preserved left ventricular ejection fraction. PLoS One 10(2):e0117332. https://doi.org/10.1371/journal.pone.0117332 CrossRefPubMedPubMedCentral

Floras JS, Ponikowski P (2015) The sympathetic/parasympathetic imbalance in heart failure with reduced ejection fraction. Eur Heart J 36(30):1974–1982. https://doi.org/10.1093/eurheartj/ehv087

Phan TT, Shivu GN, Abozguia K et al (2010) Impaired heart rate recovery and chronotropic incompetence in patients with heart failure with preserved ejection fraction. Circ Heart Fail 3:29–34

Pearson M, Mungovan S, Smart N (2017) Effect of exercise on diastolic function in heart failure patients: a systematic review and meta-analysis. Heart Fail Rev 22(2):229–242. https://doi.org/10.1007/s10741-017-9600-0 CrossRefPubMed

Pearson M, Smart N (2017) Effect of exercise training on endothelial function in heart failure patients: a systematic review meta-analysis. Int J Cardiol 231:234–243. https://doi.org/10.1016/j.ijcard.2016.12.145 CrossRefPubMed

Taylor RS, Sagar VA, Davies EJ et al (2014) Exercise-based rehabilitation for heart failure. Cochrane Libr

Dieberg G, Ismail H, Giallauria F, Smart NA (2015) Clinical outcomes and cardiovascular responses to exercise training in preserved ejection fraction heart failure patients: systematic review & meta-analysis. J Appl Physiol 119(6):726–733. https://doi.org/10.1152/japplphysiol.00904.2014 CrossRefPubMed

Gademan MG, Swenne CA, Verwey HF et al (2007) Effect of exercise training on autonomic derangement and neurohumoral activation in chronic heart failure. J Card Fail 13(4):294–303. https://doi.org/10.1016/j.cardfail.2006.12.006 CrossRefPubMed

10.

Adamopoulos S, Ponikowski P, Cerquetani E et al (1995) Circadian pattern of heart rate variability in chronic heart failure patients effects of physical training. Eur Heart J 16(10):1380–1386. https://doi.org/10.1093/oxfordjournals.eurheartj.a060746 CrossRefPubMed

11.

Coats AJ, Adamopoulos S, Radaelli A, McCance A, Meyer TE, Bernardi L, Solda PL, Davey P, Ormerod O, Forfar C (1992) Controlled trial of physical training in chronic heart failure. Exercise performance, hemodynamics, ventilation, and autonomic function. Circulation 85(6):2119–2131. https://doi.org/10.1161/01.CIR.85.6.2119 CrossRefPubMed

12.

Nanas S, Anastasiou-Nana M, Dimopoulos S, Sakellariou D, Alexopoulos G, Kapsimalakou S, Papazoglou P, Tsolakis E, Papazachou O, Roussos C, Nanas J (2006) Early heart rate recovery after exercise predicts mortality in patients with chronic heart failure. Int J Cardiol 110(3):393–400. https://doi.org/10.1016/j.ijcard.2005.10.032 CrossRefPubMed

13.

Arena R, Myers J, Abella J, Peberdy MA, Bensimhon D, Chase P, Guazzi M (2010) The prognostic value of the heart rate response during exercise and recovery in patients with heart failure: influence of beta-blockade. Int J Cardiol 138(2):166–173. https://doi.org/10.1016/j.ijcard.2008.08.010 CrossRefPubMed

14.

Cahalin LP, Arena R, Labate V, Bandera F, Lavie CJ, Guazzi M (2013) Heart rate recovery after the 6 min walk test rather than distance ambulated is a powerful prognostic indicator in heart failure with reduced and preserved ejection fraction: a comparison with cardiopulmonary exercise testing. Eur J Heart Fail 15(5):519–527. https://doi.org/10.1093/eurjhf/hfs216 CrossRefPubMed

15.

Barretto AC, Santos AC, Munhoz R et al (2009) Increased muscle sympathetic nerve activity predicts mortality in heart failure patients. Int J Cardiol 135(3):302–307. https://doi.org/10.1016/j.ijcard.2008.03.056 CrossRefPubMed

16.

Galinier M, Pathak A, Fourcade J, Androdias C, Curnier D, Varnous S, Boveda S, Massabuau P, Fauvel M, Senard JM, Bounhoure JP (2000) Depressed low frequency power of heart rate variability as an independent predictor of sudden death in chronic heart failure. Eur Heart J 21(6):475–482. https://doi.org/10.1053/euhj.1999.1875 CrossRefPubMed

17.

Cole CR, Blackstone EH, Pashkow FJ, Snader CE, Lauer MS (1999) Heart-rate recovery immediately after exercise as a predictor of mortality. N Engl J Med 341(18):1351–1357. https://doi.org/10.1056/NEJM199910283411804 CrossRefPubMed

18.

Tang Y-D, Dewland TA, Wencker D, Katz SD (2009) Post-exercise heart rate recovery independently predicts mortality risk in patients with chronic heart failure. J Card Fail 15(10):850–855. https://doi.org/10.1016/j.cardfail.2009.06.437 CrossRefPubMedPubMedCentral

19.

Arena R, Guazzi M, Myers J, Peberdy MA (2006) Prognostic value of heart rate recovery in patients with heart failure. Am Heart J 151(4):851. e857–851. e813CrossRef

20.

Guazzi M, Myers J, Peberdy MA, Bensimhon D, Chase P, Arena R (2010) Heart rate recovery predicts sudden cardiac death in heart failure. Int J Cardiol 144(1):121–123. https://doi.org/10.1016/j.ijcard.2008.12.149 CrossRefPubMed

21.

Carnethon MR, Jacobs DR Jr, Sidney S et al (2005) A longitudinal study of physical activity and heart rate recovery: CARDIA, 1987–1993. Med Sci Sports Exerc 37(4):606–612. https://doi.org/10.1249/01.MSS.0000158190.56061.32 CrossRefPubMed

22.

Darr KC, Bassett DR, Morgan BJ, Thomas DP (1988) Effects of age and training status on heart rate recovery after peak exercise. Am J Phys Heart Circ Phys 254(2):H340–H343

23.

Du N, Bai S, Oguri K, Kato Y, Matsumoto I, Kawase H, Matsuoka T (2005) Heart rate recovery after exercise and neural regulation of heart rate variability in 30–40 year old female marathon runners. J Sports Sci Med 4(1):9–17PubMedPubMedCentral

24.

Peçanha T, Bartels R, Brito LC, Paula-Ribeiro M, Oliveira RS, Goldberger JJ (2017) Methods of assessment of the post-exercise cardiac autonomic recovery: a methodological review. Int J Cardiol 227:795–802. https://doi.org/10.1016/j.ijcard.2016.10.057 CrossRefPubMed

25.

Jehn M, Halle M, Schuster T, Hanssen H, Koehler F, Schmidt-Trucksäss A (2011) Multivariable analysis of heart rate recovery after cycle ergometry in heart failure: exercise in heart failure. Heart Lung: J Acute Crit Care 40(6):e129–e137. https://doi.org/10.1016/j.hrtlng.2011.01.005 CrossRef

26.

Imai K, Sato H, Hori M, Kusuoka H, Ozaki H, Yokoyama H, Takeda H, Inoue M, Kamada T (1994) Vagally mediated heart rate recovery after exercise is accelerated in athletes but blunted in patients with chronic heart failure. J Am Coll Cardiol 24(6):1529–1535. https://doi.org/10.1016/0735-1097(94)90150-3 CrossRefPubMed

27.

Camm AJ, Malik M, Bigger JT et al (1996) Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation 93(5):1043–1065CrossRef

28.

Goldberger AL (1991) Is the normal heartbeat chaotic or homeostatic? Physiology 6(2):87–91CrossRef

29.

Nolan J, Batin PD, Andrews R, Lindsay SJ, Brooksby P, Mullen M, Baig W, Flapan AD, Cowley A, Prescott RJ, Neilson JMM, Fox KAA (1998) Prospective study of heart rate variability and mortality in chronic heart failure. Circulation 98(15):1510–1516. https://doi.org/10.1161/01.CIR.98.15.1510 CrossRefPubMed

30.

Sandercock GR, Bromley PD, Brodie DA (2005) Effects of exercise on heart rate variability: inferences from meta-analysis. Med Sci Sports Exerc 37(3):433–439. https://doi.org/10.1249/01.MSS.0000155388.39002.9D CrossRefPubMed

31.

Routledge FS, Campbell TS, McFetridge-Durdle JA, Bacon SL (2010) Improvements in heart rate variability with exercise therapy. Can J Cardiol 26(6):303–312. https://doi.org/10.1016/S0828-282X(10)70395-0 CrossRefPubMedPubMedCentral

32.

Larsen AI, Gjesdal K, Hall C, Aukrust P, Aarsland T, Dickstein K (2004) Effect of exercise training in patients with heart failure: a pilot study on autonomic balance assessed by heart rate variability. Eur J Cardiovasc Prev Rehabil 11(2):162–167. https://doi.org/10.1097/01.hjr.0000124214.21584.bb CrossRefPubMed

33.

Sassi R, Cerutti S, Lombardi F, Malik M, Huikuri HV, Peng CK, Schmidt G, Yamamoto Y, Document Reviewers L, Gorenek B, Lip GYH, Grassi G, Kudaiberdieva G, Fisher JP, Zabel M, Macfadyen R (2015) Advances in heart rate variability signal analysis: joint position statement by the e-Cardiology ESC Working Group and the European Heart Rhythm Association co-endorsed by the Asia Pacific Heart Rhythm Society. Europace 17(9):1341–1353. https://doi.org/10.1093/europace/euv015 CrossRefPubMed

34.

Shaffer F, McCraty R, Zerr CL (2014) A healthy heart is not a metronome: an integrative review of the heart's anatomy and heart rate variability. Front Psychol 5:1040. https://doi.org/10.3389/fpsyg.2014.01040 CrossRefPubMedPubMedCentral

35.

Billman GE (2011) Heart rate variability—a historical perspective. Front Physiol 2:86. https://doi.org/10.3389/fphys.2011.00086 CrossRefPubMedPubMedCentral

36.

Carter JR, Ray CA (2015) Sympathetic neural adaptations to exercise training in humans. Auton Neurosci 188:36–43. https://doi.org/10.1016/j.autneu.2014.10.020 CrossRefPubMed

37.

Parati G, Esler M (2012) The human sympathetic nervous system: its relevance in hypertension and heart failure. Eur Heart J 33(9):1058–1066. https://doi.org/10.1093/eurheartj/ehs041 CrossRefPubMed

38.

Leimbach WN, Wallin BG, Victor RG, Aylward PE, Sundlöf G, Mark AL (1986) Direct evidence from intraneural recordings for increased central sympathetic outflow in patients with heart failure. Circulation 73(5):913–919. https://doi.org/10.1161/01.CIR.73.5.913 CrossRefPubMed

39.

Notarius CF, Millar PJ, Floras JS (2015) Muscle sympathetic activity in resting and exercising humans with and without heart failure 1. Appl Physiol Nutr Metab 40(11):1107–1115. https://doi.org/10.1139/apnm-2015-0289 CrossRefPubMed

40.

Hsu C-Y, Hsieh P-L, Hsiao S-F, Chien M-Y (2015) Effects of exercise training on autonomic function in chronic heart failure: systematic review. Biomed Res Int 2015:591708. https://doi.org/10.1155/2015/591708 PubMedPubMedCentral

41.

Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560. https://doi.org/10.1136/bmj.327.7414.557 CrossRefPubMedPubMedCentral

42.

Egger M, Smith GD, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315(7109):629–634. https://doi.org/10.1136/bmj.315.7109.629 CrossRefPubMedPubMedCentral

43.

Smart NA, Waldron M, Ismail H, Giallauria F, Vigorito C, Cornelissen V, Dieberg G (2015) Validation of a new tool for the assessment of study quality and reporting in exercise training studies: TESTEX. Int J Evid Based Healthc 13(1):9–18. https://doi.org/10.1097/XEB.0000000000000020 CrossRefPubMed

44.

Fraga R, Franco FG, Roveda F, de Matos LNJ, Braga AMFW, Rondon MUPB, Rotta DR, Brum PC, Barretto ACP, Middlekauff HR, Negrão CE (2007) Exercise training reduces sympathetic nerve activity in heart failure patients treated with carvedilol. Eur J Heart Fail 9(6–7):630–636. https://doi.org/10.1016/j.ejheart.2007.03.003 CrossRefPubMed

45.

Keyhani D, Kargarfard M, Sarrafzadegan N, Sadeghi M (2013) Autonomic function change following a supervised exercise program in patients with congestive heart failure. ARYA Atheroscler 9(2):150–156PubMedPubMedCentral

46.

Myers J, Hadley D, Oswald U, Bruner K, Kottman W, Hsu L, Dubach P (2007) Effects of exercise training on heart rate recovery in patients with chronic heart failure. Am Heart J 153(6):1056–1063. https://doi.org/10.1016/j.ahj.2007.02.038 CrossRefPubMed

47.

Tsarouhas K, Karatzaferi C, Tsitsimpikou C, Haliassos A, Kouretas D, Pavlidis P, Veskoukis A, Adamopoulos S, Kyriakides Z, Constantinou L, Koutedakis Y, Rentoukas E (2011) Effects of walking on heart rate recovery, endothelium modulators and quality of life in patients with heart failure. Eur J Cardiovasc Prev Rehabil: Off J Eur Soc Cardiol Work Groups Epidemiol Prev Card Rehabil Exerc Physiol 18(4):594–600. https://doi.org/10.1177/1741826710397099 CrossRef

48.

Yaylalı YT, Fındıkoğlu G, Yurtdaş M, Konukçu S, Şenol H (2015) The effects of baseline heart rate recovery normality and exercise training protocol on heart rate recovery in patients with heart failure. Anatol J Cardiol 15(9):727–734. https://doi.org/10.5152/akd.2014.5710 CrossRefPubMed

49.

Cider A, Tygesson H, Hedberg M, Seligman L, Wennerblom B, Sunnerhagen K (1997) Peripheral muscle training in patients with clinical signs of heart failure. Scand J Rehabil Med 29(2):121–127PubMed

50.

Krishna BH, Pal P, Pal G et al (2014) Effect of yoga therapy on heart rate, blood pressure and cardiac autonomic function in heart failure. J Clin Diagn Res 8(1):14–16. https://doi.org/10.7860/JCDR/2014/7844.3983 PubMedPubMedCentral

51.

Kiilavuori K, Toivonen L, Näveri H, Leinonen H (1995) Reversal of autonomic derangements by physical training in chronic heart failure assessed by heart rate variability. Eur Heart J 16(4):490–495. https://doi.org/10.1093/oxfordjournals.eurheartj.a060941 CrossRefPubMed

52.

Malfatto G, Branzi G, Riva B, Sala L, Leonetti G, Facchini M (2002) Recovery of cardiac autonomic responsiveness with low-intensity physical training in patients with chronic heart failure. Eur J Heart Fail 4(2):159–166. https://doi.org/10.1016/S1388-9842(01)00221-5 CrossRefPubMed

53.

Mello PR, Guerra GM, Borile S, Rondon MU, Alves MJ, Negrão CE, Dal Lago P, Mostarda C, Irigoyen MC, Consolim-Colombo FM (2012) Inspiratory muscle training reduces sympathetic nervous activity and improves inspiratory muscle weakness and quality of life in patients with chronic heart failure. J Cardiopulm Rehabil Prev 32(5):255–261. https://doi.org/10.1097/HCR.0b013e31825828da CrossRefPubMed

54.

Murad K, Brubaker PH, Fitzgerald DM, Morgan TM, Goff DC Jr, Soliman EZ, Eggebeen JD, Kitzman DW (2012) Exercise training improves heart rate variability in older patients with heart failure: a randomized, controlled, single-blinded trial. Congest Heart Fail 18(4):192–197. https://doi.org/10.1111/j.1751-7133.2011.00282.x CrossRefPubMedPubMedCentral

55.

Piotrowicz E, Piotrowski W, Piotrowicz R (2016) Positive effects of the reversion of depression on the sympathovagal balance after telerehabilitation in heart failure patients. Ann Noninvasive Electrocardiol 21(4):358–368. https://doi.org/10.1111/anec.12320 CrossRefPubMed

56.

Ricca-Mallada R, Migliaro ER, Piskorski J, Guzik P (2012) Exercise training slows down heart rate and improves deceleration and acceleration capacity in patients with heart failure. J Electrocardiol 45(3):214–219. https://doi.org/10.1016/j.jelectrocard.2012.01.002 CrossRefPubMed

57.

Ricca-Mallada R, Migliaro ER, Silvera G, Chiappella L, Frattini R, Ferrando-Castagnetto F (2017) Functional outcome in chronic heart failure after exercise training: possible predictive value of heart rate variability. Ann Phys Rehabil Med 60(2):87–94. https://doi.org/10.1016/j.rehab.2016.12.003 CrossRefPubMed

58.

Selig SE, Carey MF, Menzies DG et al (2004) Moderate-intensity resistance exercise training in patients with chronic heart failure improves strength, endurance, heart rate variability, and forearm blood flow. J Card Fail 10(1):21–30. https://doi.org/10.1016/S1071-9164(03)00583-9 CrossRefPubMed

59.

Yeh GY, Mietus JE, Peng CK, Phillips RS, Davis RB, Wayne PM, Goldberger AL, Thomas RJ (2008) Enhancement of sleep stability with Tai Chi exercise in chronic heart failure: preliminary findings using an ECG-based spectrogram method. Sleep Med 9(5):527–536. https://doi.org/10.1016/j.sleep.2007.06.003 CrossRefPubMed

60.

Antunes-Correa LM, Nobre TS, Groehs RV, Alves MJNN, Fernandes T, Couto GK, Rondon MUPB, Oliveira P, Lima M, Mathias W, Brum PC, Mady C, Almeida DR, Rossoni LV, Oliveira EM, Middlekauff HR, Negrao CE (2014) Molecular basis for the improvement in muscle metaboreflex and mechanoreflex control in exercise-trained humans with chronic heart failure. Am J Physiol Heart Circ Physiol 307(11):H1655–H1666. https://doi.org/10.1152/ajpheart.00136.2014 CrossRefPubMedPubMedCentral

61.

de Mello Franco FG, Santos AC, Rondon MUP, Trombetta IC, Strunz C, Braga AMW, Middlekauff H, Negrão CE, Barretto ACP (2006) Effects of home-based exercise training on neurovascular control in patients with heart failure. Eur J Heart Fail 8(8):851–855. https://doi.org/10.1016/j.ejheart.2006.02.009 CrossRefPubMed

62.

Nobre TS, Antunes-Correa LM, Groehs RV, Alves MJNN, Sarmento AO, Bacurau AV, Urias U, Alves GB, Rondon MUPB, Brum PC, Martinelli M, Middlekauff HR, Negrao CE (2016) Exercise training improves neurovascular control and calcium cycling gene expression in patients with heart failure with cardiac resynchronization therapy. Am J Physiol Heart Circ Physiol 311(5):H1180–H1188. https://doi.org/10.1152/ajpheart.00275.2016 CrossRefPubMed

63.

Roveda F, Middlekauff HR, Rondon MUPB, Reis SF, Souza M, Nastari L, Barretto ACP, Krieger EM, Negrão CE (2003) The effects of exercise training on sympathetic neural activation in advanced heart failure: a randomized controlled trial. J Am Coll Cardiol 42(5):854–860. https://doi.org/10.1016/S0735-1097(03)00831-3 CrossRefPubMed

64.

Dimopoulos S, Manetos C, Panagopoulou N, Karatzanos L, Nanas S (2015) The prognostic role of heart rate recovery after exercise in health and disease. Austin J Cardiovasc Dis Atheroscler 2(2):1014

65.

Streuber SD, Amsterdam EA, Stebbins CL (2006) Heart rate recovery in heart failure patients after a 12-week cardiac rehabilitation program. Am J Cardiol 97(5):694–698. https://doi.org/10.1016/j.amjcard.2005.09.117 CrossRefPubMed

66.

Dimopoulos S, Anastasiou-Nana M, Sakellariou D, Drakos S, Kapsimalakou S, Maroulidis G, Roditis P, Papazachou O, Vogiatzis I, Roussos C, Nanas S (2006) Effects of exercise rehabilitation program on heart rate recovery in patients with chronic heart failure. Eur J Cardiovasc Prev Rehabil 13(1):67–73. https://doi.org/10.1097/00149831-200602000-00010 CrossRefPubMed

67.

Dimopoulos S (2015) Abnormal heart rate recovery in patients with heart failure: an important target for exercise training treatment. Anatol J Cardiol 15(9):735–736. https://doi.org/10.5152/AnatolJCardiol.2015.16529 CrossRefPubMedPubMedCentral

68.

Nishime EO, Cole CR, Blackstone EH, Pashkow FJ, Lauer MS (2000) Heart rate recovery and treadmill exercise score as predictors of mortality in patients referred for exercise ECG. JAMA 284(11):1392–1398. https://doi.org/10.1001/jama.284.11.1392 CrossRefPubMed

69.

Shetler K, Marcus R, Froelicher VF, Vora S, Kalisetti D, Prakash M, Do D, Myers J (2001) Heart rate recovery: validation and methodologic issues. J Am Coll Cardiol 38(7):1980–1987. https://doi.org/10.1016/S0735-1097(01)01652-7 CrossRefPubMed

70.

Maeder MT, Ammann P, Rickli H, Brunner-La Rocca HP (2009) Impact of the exercise mode on heart rate recovery after maximal exercise. Eur J Appl Physiol 105(2):247–255. https://doi.org/10.1007/s00421-008-0896-2 CrossRefPubMed

71.

Cunha FA, Midgley AW, Gonçalves T, Soares PP, Farinatti P (2015) Parasympathetic reactivation after maximal CPET depends on exercise modality and resting vagal activity in healthy men. Spring 4(1):100. https://doi.org/10.1186/s40064-015-0882-1 CrossRef

72.

Buchheit M, Laursen PB, Ahmaidi S (2007) Parasympathetic reactivation after repeated sprint exercise. Am J Phys Heart Circ Phys 293(1):H133–H141

73.

Medeiros WM, Luca FA, Figueredo Júnior AR, Mendes FA, Gun C (2017) Heart rate recovery improvement in patients following acute myocardial infarction: exercise training, β-blocker therapy or both. Clin Physiol Funct Imaging. https://doi.org/10.1111/cpf.12420

74.

Lipinski MJ, Vetrovec GW, Gorelik D, Froelicher VF (2005) The importance of heart rate recovery in patients with heart failure or left ventricular systolic dysfunction. J Card Fail 11(8):624–630. https://doi.org/10.1016/j.cardfail.2005.06.429 CrossRefPubMed

75.

Snoek JA, van Berkel S, van Meeteren N, Backx FJ, Daanen HA (2013) Effect of aerobic training on heart rate recovery in patients with established heart disease; a systematic review. PLoS One 8(12):e83907. https://doi.org/10.1371/journal.pone.0083907 CrossRefPubMedPubMedCentral

76.

Giallauria F, Lucci R, Pietrosante M, Gargiulo G, de Lorenzo A, D'Agostino M, Gerundo G, Abete P, Rengo F, Vigorito C (2006) Exercise-based cardiac rehabilitation improves heart rate recovery in elderly patients after acute myocardial infarction. J Gerontol Ser A Biol Med Sci 61(7):713–717. https://doi.org/10.1093/gerona/61.7.713 CrossRef

77.

Lazzeroni D, Castiglioni P, Bini M, Faini A, Camaiora U, Ugolotti PT, Centorbi CS, Brambilla L, Brambilla V, Piepoli MF, Coruzzi P (2017) Improvement in aerobic capacity during cardiac rehabilitation in coronary artery disease patients: is there a role for autonomic adaptations? Eur J Prev Cardiol 24(4):357–364. https://doi.org/10.1177/2047487316681341 CrossRefPubMed

78.

Kleiger RE, Stein PK, Bigger JT (2005) Heart rate variability: measurement and clinical utility. Ann Noninvasive Electrocardiol 10(1):88–101. https://doi.org/10.1111/j.1542-474X.2005.10101.x CrossRefPubMed

79.

Billman GE (2013) The LF/HF ratio does not accurately measure cardiac sympatho-vagal balance. Front Physiol 4:26. https://doi.org/10.3389/fphys.2013.00026 PubMedPubMedCentral

80.

Zucker IH, Schultz HD, Patel KP, Wang H (2015) Modulation of angiotensin II signaling following exercise training in heart failure. Am J Phys Heart Circ Phys 308(8):H781–H791

81.

Huang P-H, Leu H-B, Chen J-W, Cheng CM, Huang CY, Tuan TC, Ding PYA, Lin SJ (2004) Usefulness of attenuated heart rate recovery immediately after exercise to predict endothelial dysfunction in patients with suspected coronary artery disease. Am J Cardiol 93(1):10–13. https://doi.org/10.1016/j.amjcard.2003.09.004 CrossRefPubMed

82.

Smart NA, Steele M (2011) The effect of physical training on systemic proinflammatory cytokine expression in heart failure patients: a systematic review. Congest Heart Fail 17(3):110–114. https://doi.org/10.1111/j.1751-7133.2011.00217.x CrossRefPubMed

83.

Youn J-C, Lee HS, Choi S-W, Han SW, Ryu KH, Shin EC, Kang SM (2016) Post-exercise heart rate recovery independently predicts clinical outcome in patients with acute decompensated heart failure. PLoS One 11(5):e0154534. https://doi.org/10.1371/journal.pone.0154534 CrossRefPubMedPubMedCentral

84.

Haensel A, Mills PJ, Nelesen RA, Ziegler MG, Dimsdale JE (2008) The relationship between heart rate variability and inflammatory markers in cardiovascular diseases. Psychoneuroendocrinology 33(10):1305–1312. https://doi.org/10.1016/j.psyneuen.2008.08.007 CrossRefPubMedPubMedCentral

85.

Papaioannou V, Pneumatikos I, Maglaveras N (2013) Association of heart rate variability and inflammatory response in patients with cardiovascular diseases: current strengths and limitations. Front Physiol 4:174. https://doi.org/10.3389/fphys.2013.00174 CrossRefPubMedPubMedCentral

86.

Ramos S, Prata J, Bettencourt P, Gonçalves FR, Coelho R (2016) Depression predicts mortality and hospitalization in heart failure: a six-years follow-up study. J Affect Disord 201:162–170. https://doi.org/10.1016/j.jad.2016.05.024 CrossRefPubMed

87.

Mommersteeg PM, Schoemaker RG, Naudé PJ et al (2016) Depression and markers of inflammation as predictors of all-cause mortality in heart failure. Brain Behav Immun 57:144–150. https://doi.org/10.1016/j.bbi.2016.03.012 CrossRefPubMed

88.

Gathright EC, Goldstein CM, Josephson RA, Hughes JW (2017) Depression increases the risk of mortality in patients with heart failure: a meta-analysis. J Psychosom Res 94:82–89. https://doi.org/10.1016/j.jpsychores.2017.01.010 CrossRefPubMed

89.

Gathright EC, Walter FA, Hawkins MA, Spitznagel MB, Hughes JW, Gunstad J (2016) Executive function moderates the relationship between depressive symptoms and resting heart rate variability in heart failure. J Behav Med 39(2):192–200. https://doi.org/10.1007/s10865-015-9684-8 CrossRefPubMed

90.

Tu RH, Zeng ZY, Zhong GQ, Wu WF, Lu YJ, Bo ZD, He Y, Huang WQ, Yao LM (2014) Effects of exercise training on depression in patients with heart failure: a systematic review and meta-analysis of randomized controlled trials. Eur J Heart Fail 16(7):749–757. https://doi.org/10.1002/ejhf.101 CrossRefPubMed

91.

Antunes-Correa LM, Kanamura BY, Melo RC, Nobre TS, Ueno LM, Franco FGM, Roveda F, Braga AM, Rondon MUPB, Brum PC, Barretto ACP, Middlekauff HR, Negrao CE (2012) Exercise training improves neurovascular control and functional capacity in heart failure patients regardless of age. Eur J Prev Cardiol 19(4):822–829. https://doi.org/10.1177/1741826711414626 CrossRefPubMed

92.

Antunes-Correa LM, Melo RC, Nobre TS, Ueno LM, Franco FGM, Braga AMW, Rondon MUPB, Brum PC, Barretto ACP, Middlekauff HR, Negrao CE (2010) Impact of gender on benefits of exercise training on sympathetic nerve activity and muscle blood flow in heart failure. Eur J Heart Fail 12(1):58–65. https://doi.org/10.1093/eurjhf/hfp168 CrossRefPubMedPubMedCentral

93.

Antunes-Correa LM, Ueno-Pardi LM, Trevizan PF, Santos MR, da Silva CHP, Franco FGM, Alves MJNN, Rondon MUPB, Negrao CE (2017) The influence of aetiology on the benefits of exercise training in patients with heart failure. Eur J Prev Cardiol 24(4):365–372. https://doi.org/10.1177/2047487316683530 CrossRefPubMed

94.

Ueno LM, Drager LF, Rodrigues AC et al (2009) Effects of exercise training in patients with chronic heart failure and sleep apnea. Sleep 32(5):637–647. https://doi.org/10.1093/sleep/32.5.637 CrossRefPubMedPubMedCentral

95.

Groehs RV, Antunes-Correa LM, Nobre TS, Alves MJNN, Rondon MUPB, Barreto ACP, Negrão CE (2016) Muscle electrical stimulation improves neurovascular control and exercise tolerance in hospitalised advanced heart failure patients. Eur J Prev Cardiol 23(15):1599–1608. https://doi.org/10.1177/2047487316654025 CrossRefPubMed

96.

Negrao CE, Middlekauff HR, Gomes-Santos IL, Antunes-Correa LM (2015) Effects of exercise training on neurovascular control and skeletal myopathy in systolic heart failure. Am J Phys Heart Circ Phys 308(8):H792–H802

97.

Groehs RV, Toschi-Dias E, Antunes-Correa LM et al (2015) Exercise training prevents the deterioration in the arterial baroreflex control of sympathetic nerve activity in chronic heart failure patients. Am J Phys Heart Circ Phys 308(9):H1096–H1102

98.

(2017) Mechanisms and management of exercise intolerance in older heart failure patients. Retrieved from http://clinicaltrials.gov/ct

99.

von Haehling S, Hasenfuß G, Anker SD (2016) Diabetes and heart failure. J Am Coll Cardiol 68(13):1417–1419. https://doi.org/10.1016/j.jacc.2016.07.728 CrossRef

100.

Barak OF, Klasnja A, Popadic Gacesa J, Grujic NG (2014) Gender differences in parasympathetic reactivation during recovery from Wingate anaerobic test. Period Biol 116(1):53–58

101.

Billman GE, Huikuri HV, Sacha J, Trimmel K (2015) An introduction to heart rate variability: methodological considerations and clinical applications. Front Physiol 6:55. https://doi.org/10.3389/fphys.2015.00055 PubMedPubMedCentral

Title: Exercise therapy and autonomic function in heart failure patients: a systematic review and meta-analysis
Authors: M. J. Pearson
N. A. Smart
Publication date: 01-01-2018
Publisher: Springer US
Published in: Heart Failure Reviews / Issue 1/2018
Print ISSN: 1382-4147
Electronic ISSN: 1573-7322
DOI: https://doi.org/10.1007/s10741-017-9662-z

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Exercise therapy and autonomic function in heart failure patients: a systematic review and meta-analysis

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